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The authors review 149 cases of bacterial and mycotic intracranial aneurysms reported since 1957 and describe two cases of bacterial aneurysms managed in their institution. The overall mortality rate was 39%. Bacterial aneurysms accounted for 0.49-4.3% of all intracranial aneurysms. Among the reported cases, the mortality rate for patients treated with antibiotics alone was high, whereas it was low among those who underwent elective surgery. The authors conclude the following: 1) Distal aneurysms should be treated with high-dose antibiotics and followed with serial cerebral angiography at 7 days, 14 days, 1 month, 3 months, and 1 year after the initiation of therapy; 2) proximal aneurysms should be treated with high-dose antibiotics, and surgery is rarely indicated; 3) any significant associated hematoma should be evacuated and the aneurysm resected, if possible; and 4) if serial angiography shows enlargement of an aneurysm, surgery should be considered. The clinical features and management of mycotic and bacterial aneurysms are discussed in detail.

Twenty-two cases of diffuse cerebral swelling (DCS) following head injuries, rated 14 or less on the Glasgow Coma Scale (GCS) at the time of admission, were investigated. In nine cases the GCS was greater than 8, and in the remaining cases the GCS was 8 or less. This study focused on clinical features, computed tomography (CT) findings and the patient outcomes. The patients studied were classified into three age groups: the child group; aged 15 or under (9 cases), the adolescent group; aged 16 to 19 (7 cases), and the adult group; aged 20 or older (6 cases). The frequency of skull fracture was significantly higher in the adult group compared to the other two groups. Regarding the site of the impact, frontal impact was most common in the child and adolescent groups, but this tendency was not evident in the adult group. Diagnosis of DCS on CT was made within 6 hours following the injury in all cases. Initial CT findings of DCS were classified into 3 types: Type I; slightly compressed ventricular system without narrowing of the perimesencephalic (PMC) cistern (12 cases), Type II; moderately compressed ventricular system with narrowing of the PMC cistern (4 cases), and Type III; markedly compressed ventricular system with obliteration of the PMC cistern (6 cases). The average age of the cases belonging to Types I, II, and III was 11.0, 18.0, and 34.5, respectively. There were no deaths among Type I cases. On the other hand, all Type III cases died. As other CT findings associated with DCS, subarachnoid hemorrhage in the basal cisterns and intraventricular hemorrhage were critical findings which always signified primary brain stem injury. This study indicates that the degree of DCS on CT in children was far less than that in adults, and also the prognosis for children was obviously better than that for adults. It is the authors' impression that the differences between the two groups are based on two factors, i.e., strength and direction of impact.

A case of multiple cerebral tuberculomas associated with tuberculous brain abscess is presented. The characteristics of computed tomography (CT) appearance, diagnosis, pathology and treatment of cerebral tuberculoma are discussed. The patient, a 67-year-old female, was initially admitted to a sanatorium for the treatment of lung tuberculosis. She developed headache and nausea with mental confusion. She was then transferred in November 1982. A neurological examination showed that she was in a confused state, and that she had dysarthria, papilledema, neck stiffness and left hemiparesis. Enhanced CT scans showed multiple lesions, some of which were homogeneously enhanced and others were ring-like enhanced. A right occipital craniotomy was performed and a mass was excised en bloc. The mass contained purulent material. Acid-fast bacillus stain of the pus was positive and histological examination of the capsule wall demonstrated tuberculoma. Three weeks later, a right temporal craniotomy was performed, because the right temporal lesion grew rapidly. The same histological findings were obtained. Antituberculous chemotherapy was continued. One month later, the homogeneously enhanced lesions almost disappeared. However, the ring-like enhanced lesions kept growing to become multiple large masses. In January 1984, the patient remained stuporous.

A 48-year-old female developed multiple cerebral aneurysms in association with atypical moyamoya disease. At the age of 43, the basilar-superior cerebellar artery junction aneurysm was clipped successfully. Four years later a new aneurysm developed at the interpeduncular segment of the left posterior cerebral artery. It enlarged, ruptured, and was clipped successfully. Operative indication for cerebral aneurysms in the presence of cerebrovascular moyamoya disease based on radiological and operative findings, as well as their mechanism of development, are discussed.